Severe Hypoglycemia: Identifying At-risk Groups
May 1, 2016 less than 1 minute read
SOURCE: Pathak RD, et al. Severe hypoglycemia requiring medical intervention in a large cohort of adults with diabetes receiving care in U.S. integrated health care delivery systems: 2005-2011. Diabetes Care 2016;39:363-370.
There are numerous reasons to show a healthy respect for hypoglycemia in diabetic patients. First, hypoglycemia is responsible for many deaths in diabetics. Second, hypoglycemia may cause consequential injuries from falls and auto accidents. Third, hypoglycemia is included in the American Diabetes Association treatment algorithm list of five issues clinicians should address routinely when advancing pharmacologic treatment from metformin to polypharmacy. Fourth, patients often weigh issues about hypoglycemia risk as highly important in their decision process about advancing and adhering to medication.
Pathak et al reported results of an observational cohort study of almost 1 million adults participating in the Surveillance, Prevention, and Management of Diabetes Mellitus (SUPREME-DM) network who were treated during the 2005-2011 interval. Severe hypoglycemia was diagnosed among inpatients and patients presenting to emergency departments. Statistically significantly higher rates of severe hypoglycemia occurred in older patients (especially those > 75 years of age) and those with chronic kidney disease, heart failure, cardiovascular disease, and depression. Pharmacologic agents associated with higher risk of severe hypoglycemia included insulin, insulin secretagogues, and beta-blockers.
Because hypoglycemia is such an important obstacle to optimized goal attainment in diabetes, clinicians may wish to factor the above-mentioned demographics into their pharmacologic decision process.
Hypoglycemia is such an important obstacle to optimized goal attainment in diabetes.
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